SPECIAL COMMUNICATIONS
Team Physician Consensus Statement
Team Physician Consensus Statement:
2013 Update
and experience uniquely qualifies him or her to provide the
best medical care for the athlete.
This document is not intended as a standard of care and
should not be interpreted as such. It is only a guide and, as such,
is of a general nature, consistent with the reasonable, objective
practice of the healthcare profession. Adequate insurance
should be in place to help protect the physician, the athlete,
and the sponsoring organization. This document was originally developed as the first in the team physician consensus series, representing an ongoing project-based alliance of
the major professional associations concerned about clinical
sports medicine issues. The organizations are the American
Academy of Family Physicians, the American Academy of
Orthopedic Surgeons, the American College of Sports Medicine, the American Medical Society for Sports Medicine, the
American Orthopedic Society for Sports Medicine, and the
American Osteopathic Academy of Sports Medicine.
DEFINITION
Team physicians have the leadership role in the organization,
management, and provision of care of athletes in individual,
team, and mass participation sporting events. This document
describes the definition, qualifications, education, duties, and
responsibilities of the team physician fulfilling this role.
GOAL
Since the publication of this statement in 2000, the roles and
responsibilities of the team physician have evolved. The goal
of this update is to outline the duties of the team physician to
best serve athletes. To accomplish this goal, the team physician should possess, be responsible for, and/or understand
medical qualifications and education,
medical and administrative duties and responsibilities,
ethical issues, and
medicolegal issues.
PRIMARY AUTHORS
Stanley A. Herring, M.D., Chair, Seattle, WA
W. Ben Kibler, M.D., Lexington, KY
Margot Putukian, M.D., Princeton, NJ
SUMMARY
EXPERT PANEL
The Team Physician Consensus Statement delineates the
qualifications, duties, and responsibilities of the team physician and provides guidelines to individuals and organizations
in selecting team physicians. These delineations and guidelines
provide a foundation for best practices in the medical care of
athletes and teams. The team physician_s education, training,
John A. Bergfeld, M.D., Cleveland, OH
Lori Boyajian-O_Neill, D.O., Kansas City, KS
Cindy J. Chang, M.D., Berkeley, CA
R. Robert Franks, D.O., Marlton, NJ
Peter Indelicato, M.D., Gainesville, FL
Walter Lowe, M.D., Houston, TX
Yvette Rooks, M.D., Baltimore, MD
Robert Stanton, M.D., Fairfield, MD
0195-9131/13/4508-1618/0
MEDICINE & SCIENCE IN SPORTS & EXERCISEÒ
Copyright 2013 by the American College of Sports Medicine (ACSM),
American Academy of Family Physicians (AAFP), American Academy of
Orthopaedic Surgeons (AAOS), American Medical Society for Sports
Medicine (AMSSM), American Orthopaedic Society for Sports Medicine
(AOSSM), and the American Osteopathic Academy of Sports Medicine
(AOASM).
THE TEAM PHYSICIAN DEFINED
The team physician must have an unrestricted medical license and be a medical doctor (M.D.) or doctor of osteopathy
DOI: 10.1249/MSS.0b013e31829ba437
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Media training including communication skills and
knowledge of social media
MEDICAL AND ADMINISTRATIVE DUTIES
AND RESPONSIBILITIES
It is important for the team physician to be available and
accessible and to maintain sport-specific knowledge and experience to provide medical care for the athlete. The team
physician should also be involved in the medical and administrative aspects of team care (4). Certified and/or licensed
athletic trainers and other members of the athletic care network report to the team physician on medical issues. As in all
areas of medicine, there are ethical and medicolegal issues
that need to be identified and managed.
Medical Care
MEDICAL QUALIFICATIONS AND EDUCATION
Since the primary responsibility of the team physician is to
provide optimal medical care for athletes, the team physician
must possess certain qualifications and education. Additional
qualifications and education may be required for team physicians for some collegiate, national, and professional teams.
It is essential that the team physician
is an M.D. or a D.O. in good standing, with an unrestricted
license to practice medicine;
possesses a fundamental knowledge of on-field medical
emergency care (e.g., concussion, cardiac emergencies,
spinal injuries, heat-related illnesses);
is trained in basic cardiopulmonary resuscitation and
automated external defibrillator use (4); and
has a working knowledge of musculoskeletal injuries,
medical conditions, and psychological issues affecting
the athlete.
It is desirable for the team physician to have clinical training/
experience, including the following:
Medical specialty board certification
Fellowship training in sports medicine
Additional American Council of Graduate Medical Education (ACGME)/American Osteopathic Association
(AOA) certification in sports medicine
A significant portion of clinical practice focused on
sports medicine
Continuing medical education in sports medicine
Membership and participation in a sports medicine professional association or society
Involvement in teaching, research, and publications related to sports medicine
Training in advanced cardiac and trauma life support
(ACLS/ATLS)
Knowledge of medicolegal, disability, and workers_
compensation issues
Consensus Statement
It is essential that the team physician
establishes a chain of command for injury and illness
management;
coordinates the assessment and management of gameday injuries and medical problems (4);
makes the final decisions on clearance to participate,
same-day RTP, and post–game-day RTP;
understands the importance of the preparticipation examination (PPE);
understands medical management and prevention of injury and illness in athletes;
recognizes other issues that affect athletic performance,
including strength and conditioning, nutrition, ergogenic
aids, substance abuse, and psychological response to injury;
recognizes unique issues in females, master athletes, adolescent athletes, and other defined athletic populations;
integrates medical expertise with the athletic care network; and
provides for documentation and medical record keeping.
It is desirable that the team physician
is familiar with the Team Physician Consensus Statement
series (www.acsm.org);
performs the PPE;
reviews PPE performed by others to address identified
conditions that may affect athlete health and safety;
provides ongoing medical care beyond game-day/event
coverage;
is involved in injury and illness prevention;
addresses other issues that affect athletic performance,
including strength and conditioning, nutrition, ergogenic
aids, substance abuse, and psychological response to
injury;
addresses unique issues in female, master, adolescent
athletes, and other defined athletic populations;
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(D.O.). He or she has the leadership role in the organization,
management, and provision of medical care for individual,
team, and mass participation sporting events. The most important responsibility of the team physician is the medical care
of athletes at all ages and all levels of participation.
The team physician should possess special proficiency in
the prevention and care of musculoskeletal injuries and medical
conditions encountered in sports. The team physician integrates medical expertise with medical consultants, certified
and/or licensed athletic trainers, and other allied health care
professionals (athletic care network). Aided by the athletic
care network, the team physician also educates athletes,
coaches, parents/guardians, and administrators. The team
physician is ultimately responsible for the clearance to participate and the return-to-play (RTP) decision (5).
understands the effect of exercise and sports participation
on medical conditions as well as the effect of medical
conditions on exercise and sports participation;
develops and participate in the selection of the athletic
care network; and
educates athletes, parents/guardians, coaches, and administrators.
Administrative Duties
It is essential that the team physician
is aware of or involved in the development and rehearsal
of an emergency action plan (1,4);
is aware of or involved in other aspects of sideline and
event preparedness (e.g., environmental concerns, supplies, equipment, medication, policies, postseason review
[1,4]); and
develops an agreement of medical care and administrative responsibilities between the team physician and the
organizing body, including a reporting structure from the
athletic care network (4).
It is desirable that the team physician
oversees the development and implementation of the
emergency action plan as well as other aspects of sideline
or event preparedness;
obtains a written agreement outlining medical care and
administrative responsibilities (4); and
educates athletes, parents/guardians, administrators,
coaches, and other interested parties.
ETHICAL ISSUES
Ethical challenges are present for all physicians, including
team physicians. These challenges may have unique presentations in sports medicine. Examples of ethical challenges include the following:
Confidentiality: respecting the rights of patients and
safeguarding confidences within the constraints of the
law. The confidentiality relationship with athletes may
need to be clarified in advance. Examples include the
following:
) Information disclosure compliant with the Health Insurance Portability and Accountability Act (HIPPA)
and the Family Educational Rights and Privacy Act
(FERPA)
) Athlete_s medical and psychological conditions that
affect participation and well-being (2)
) Athlete_s medical condition(s) that affects other
participants
) Drug testing results
Informed consent: the content of information and the
process of supplying information in order for the athlete
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and/or parent/guardian to make an informed decision.
Examples include the following:
) Discussion of all reasonable treatment options, including short- and long-term risks and benefits
) Athlete autonomy/desires versus optimal medical
treatment
) Occasions and locations for which informed consent
must be given in time-sensitive situations (e.g., training rooms, sideline)
Conflict of interest: any factor that may compete or interfere with the physician/patient relationship. The disclosure and management of potential conflicts is essential.
Examples include the following:
) Financial relationships with industry
) Financial relationships with a team/organization
) Personal/professional gain versus welfare of the
athlete
Influence of third parties: implicit or explicit influence
on medical decision making. Examples include the
following:
) Pressure from teammates, coaches, and administrators
) Pressure from parents/guardians, community, media,
and social media
Drug use. Examples of ethical challenges include the
following:
) Pressure to supply/administer, hide use of or provide
counsel regarding illegal, illicit, or performanceenhancing drugs
) The use of local or systemic pain medications to allow
participation
Advertising/marketing/publicity. Examples of ethical
challenges include the following:
) Individual or corporate payment to the team to be a
team physician
) Individual, corporate, or institutional payment to the
team for sponsorship or naming rights
New products and technology. An example of an ethical
challenge is as follows:
) Endorsement, utilization, or prescription of treatments,
medications, devices, and equipment without evidence
of efficacy or safety.
The overriding principle for all physicians, including team
physicians, in managing ethical issues is to provide care focused on what is best for the patient and only for the patient.
An effective way to address ethical challenges is to obtain
the greatest possible clarity regarding the team physician_s
relationship with all interested parties (athlete, parent/guardian,
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MEDICOLEGAL ISSUES
Medicolegal issues are present for all physicians, including
team physicians. Some ethical issues may also be viewed in a
medicolegal context (6). Medicolegal issues may have unique
presentation in sports medicine. Some key areas of potential
medicolegal liability include the following:
Compliance with school and governing body guidelines,
standards, policies, regulations, and rules (3,4)
Compliance with local, state, and/or federal rules, regulations, and laws (3,4)
Compliance with privacy laws (HIPPA and FERPA)
Decisions made as a result of the PPE, clearance to play,
waivers, and RTP
Evaluation and management of significant on-field injuries and illnesses (e.g., concussion, cervical spine, cardiac,
and heat-related illness)
Medical record documentation
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